Psoriasis Help Organisation - Online Psoriasis Forum

Palmo Plantar Psoriasis
 
What is it?

Palmo Plantar Psoriasis or Palmoplantar Pustulosis (‘PPP’) looks very different to plaque or flexural psoriasis. It is normally found on the palms of the hands and/or the soles of the feet (thus the name ‘palm’ and ‘plant’).  

What does it look like?  

Unlike plaque psoriasis, there are no red, scaly lesions, rather a mass of weeping, cracked areas which look like tiny, yellowish blisters. These can be very painful and sore and look ‘infected’, even though there is no actual infection present within the pustules.  

The pustules can turn a brown colour over a matter of days and fall off, only to be replaced by new yellow blisters again. This turnaround can occur many times, even lasting years.  

Occasionally, the hands and feet can be affected by thick, crusty lesions and there are no pustules present. This type of psoriasis is referred to as ‘palmar’ or ‘plantar’ respectively.  

There is strong evidence that smoking can worsen PPP.  

Treatments and Tips  

Most doctors treat PPP with topical therapies in the first instance. These are various and can be steroid-based. A good tip for topical application is to soak the affected areas in warm water before applying the ointments, keeping the skin slightly damp. Some doctors also advocate the use bandaging or covering the affected areas after applying the topical to help the ointment penetrate more fully (‘occlusion’). However, this should only be done when directed by the doctor, as some ointments (particularly steroids) should not be used in this way.  

Some docs like to move on to systemic therapies if the above have had little affect. Acitretin (soriatane) has the best clearance rate for PPP, but MTX and Cyclosporine can be used too.  

PUVA or UVB therapy can also be used and some derm units have hand and feet UV units so that only the affected areas are treated.  

Combination therapy of Acitretin and UV can be particularly good for clearance.